Chapter 514 - Nursing Facility Services - DHHR - State of West ...

ownership and control has occurred because there has been a complete purchase of assets, aprojected rate is established.At the end of the projected rate period, the audited cost report of the facility will be reconciledwith the projected cost reimbursement using actual occupancy and tested for reasonablenessagainst the cost standard established for the bed groups (0-90 beds and 91+ beds).Overpayment identified in the reconciliation process will be recovered by the Department inaccordance with the provision of Common Chapter 800, General Administration.A projected rate for a new facility or a facility with a recognized change of ownership and controlwill be established as follows:a. Standard Services - The cost standard CAP (Cost Average Point) established for thebed groupb. Mandated Services - The cost standard CAP established for the bed groupc. Nursing Services - The average of the cost established for the bed groupd. Cost of Capital - The Standard Appraised Value (SAV) methodology is applied to a newfacility or the SAV established for the facility if a change of ownership occursFull disclosure of ownership is required on the cost report. Refer to page WV2 and WV 3 on thecost report for information requested.514.13.10 Maintenance of RecordsA desk review of the cost report will be done prior to rate setting and an on-site audit of facilityrecords will be conducted periodically. Financial and statistical records must be maintained bythe facility to support and verify the information submitted on the cost reports. Such recordsmust be maintained for a minimum of five years from the ending date of the report. Uponrequest by the DHHR, all records will be made available within 10 working days. If notproduced within that time frame, the records will be considered non-existent. The DHHRreserves the right to determine the site where the records are to be made available. Costs orcensus data reported that are found to be unsubstantiated or related to records requested butnot produced will be disallowed.514.13.11 Census DataProviders shall include with the cost report a detail of census data and bed reservations billed toMedicaid for the cost reporting period.Upon request for desk review or audit, source documentation for census as reported on the costreport must include at a minimum a midnight census (by payer class with bed reservationsspecifically identified) that agrees in aggregate to a monthly census (by payer class with bedreservations specifically identified), which agrees (or has an accompanying reconciliation) toeach month as reported on the cost report, with bed reservations specifically identified.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 56January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.